COLUMBIA – A state agency tasked with caring for some of South Carolina's most vulnerable residents, an agency with problems that have been detailed in recent years by The Greenville News, needs more oversight and accountability, a state House panel has decided.

The House Legislative Oversight Committee has overwhelmingly endorsed a proposal to place the state Department of Disabilities and Special Needs in the governor's cabinet. It also recommends that all county special needs boards become advisory bodies and that their county employees become state workers, in effect making local agencies part of the DDSN.

The recommendations from the bipartisan panel last month are the strongest action to date by lawmakers concerning the agency.

The recommendations come after a series of articles by The Greenville News during the past two years detailing allegations of abuse and neglect, long waiting lists for services, questions of financial stewardship and problems with local boards.

With an annual budget of about $762 million, most of it through federal funding, the DDSN oversees the care of people with intellectual disabilities, autism, and brain and spinal-cord injuries through a network of dozens of county disabilities agencies, DDSN-run regional centers, and private for-profit and nonprofit service providers.

The agency currently operates at the direction of a seven-member commission that hires an executive director. Though the governor appoints commission members with the advice and consent of the Senate, the DDSN is not under the governor's direct control.

The committee's recommendation is not legislation. A bill would have to pass the Legislature and win approval from the governor.

Lawmakers and advocates say change is needed, though the agency already has addressed issues by establishing a plan to overhaul its complex payment system, creating financial penalties for local boards that repeatedly show problems in audits, and increasing wages for direct-care staff.

According to a survey by a national association of disability agency directors, of 33 states responding to the survey, only South Carolina managed its disabilities agency as a stand-alone department with a director appointed by the agency commission. In all other states, the agency is directly controlled by the governor or by a cabinet agency director, reports to the state's Medicaid director or is operated within the state's Medicaid agency.

State Rep. Phyllis Henderson, a Greenville Republican who chaired the subcommittee that studied DDSN for more than a year, told colleagues that based on testimony and other information received by the panel, she believed DDSN needs to fall under the direct control of the governor for a number of reasons, including:

► DDSN has not established a single regulation in 20 years. Henderson said agencies routinely create regulations which have the force of law. DDSN issues "directives" that are not legally binding, she said.

► DDSN commissioners have not been regularly trained on their responsibilities or how they fit into the agency structure.

► The agency's board at times has "rubber-stamped" director requests. Henderson said since board members may not have known enough about their roles, they may not have known to question the director over the budget or payments or other issues to help decide important policy matters.

"I personally believe that, given the complexity of what is happening with this agency, and we are the only state that does it this way, we would be better served as a state and I think the constituents would be better served by making this a cabinet agency," Henderson told the committee.

"The Commission believes its form of governance with greater stakeholder and citizen access and responsiveness can more reliably stimulate positive change than a more bureaucratic form of governance," he wrote.

Allegations not part of online dashboard

Among findings by The Greenville News from the past two years:

► A DDSN online dashboard rating the agency's providers did not include rates of abuse, neglect and exploitation allegations. The agency said then that it planned to add such data in the future as the system developed.

► Eighteen of the residential providers with scores that would equal an A on the dashboard had rates of abuse allegations, critical incidents or deaths higher than the statewide rate, records show. And two of the providers that scored 100 also had rates above the statewide rate in one of those three indicators, which are not included on the dashboard.

► A waiting list for DDSN services totaled nearly 8,000 people. As of August, according to the agency, 8,319 were on the waiting list for DDSN's major program, the ID/RD. Officials calculated it would take $19.7 million to eliminate the waiting list. The average waiting time, according to DDSN, is 3.4 years, compared to 4.6 years in 2015.

► More than 30 percent of service providers chose not to use a program to train and certify workers to administer medications to intellectually disabled consumers the preceding year, DDSN reported in 2016. The agency revised its directive on medications training and alerted providers not to allow uncertified workers to handle out medications.

► In more than half of DDSN audits conducted over a three-year period, dozens of county disabilities and special needs boards were cited for failing to properly manage the funds and property of some "consumers," which is the term used to describe the disabled who receive services from the agencies. The audits also cited many boards for sloppy financial management, including pjersonal use of boards' credit cards, inadequate cash and inventory controls, and spending issues.

► The Legislature's watchdog agency issued two highly critical performance audit reports about DDSN over the past decade, but some of its recommendations for legislation have gone unheeded by lawmakers.

The legislative committee's proposal would keep the DDSN's board of commissioners but make it an advisory panel.

'If there's a better solution, I don't know what that would be'

Robin Blackwood, a Greenville special needs parent and volunteer, said she is not a strong supporter of any particular proposal but believes change is needed.

"I'm not sure if this solution will make things better for families. If it does, I think it's a great thing," she said. "If there's a better solution, I don't know what that would be, but I just know things have to change."

She said the key to an improved agency is a commitment from leaders.

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A basic primer on how the South Carolina Department of Disabilities and Special Needs system is set up.
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"If the leaders aren't in touch with this community and really understand what we deal with on a daily basis, it's not going to be good anywhere," she said. "Basically, anything that's ever been done that's been a huge improvement for services, for opportunity, for civil liberties, has always come from passionate parents, people who understand the issues and work tirelessly to improve them."

The lone vote against the recommendations came from Rep. Robert Williams, a Darlington Democrat and former worker at a county special needs board who asked panel members to give the agency "a chance" under its new director.

"I think we're acting prematurely because of what happened in the past," Williams said.

'Ambitious agenda' to make improvements

Mary Poole, DDSN's new executive director, was appointed this summer to succeed Maley, who was appointed after long-time director Beverly Buscemi announced she would leave the agency in December 2017. Poole is the former director of York County's disabilities agency.

Last week, she recalled her testimony in November 2017 when she told lawmakers that if things didn't change, then perhaps DDSN needed to be made a cabinet agency.

But she told the oversight panel that things at the agency have changed since then. She said she has an "ambitious agenda" to look at many more changes, and she said placing the governor in direct control of the agency could mean a new director with each new governor — a prospect that could hinder stability.

"At this point in time, I would say the structure needs to be independent," Poole said. "There are a lot of changes that need to happen in this agency, from structure to service definitions to funding sources."

Henderson said the agency must be made more accountable to the public.

Henderson said DDSN should have equal footing with the Department of Health and Human Services — the state's Medicaid agency — and the Department of Mental Health, both cabinet agencies, to improve oversight and accountability.

Recommendation for an adult abuse registry

Committee chairman Weston Newton, a Beaufort County Republican, said he believes the recommendations will improve the agency's services.

"Perhaps if it had existed in the past we would not have had some of the challenges we had," he said.

Rep. Chandra Dillard, a Greenville Democrat and member of the panel, asked Poole if there was a mechanism to keep those who commit abuse and neglect in the system from finding jobs at another county agency.

Poole said while there is no state adult abuse registry, county providers have an agreement to share information. She said there is a "pretty high bar" for prosecution of abuse cases, though agencies can fire employees for policy violations.

She said she is more worried about such employees finding jobs at assisted living facilities, which may not know the circumstances of prospective employees' pasts.

Dillard, who has proposed legislation to install cameras in common areas of public facilities, asked Poole about the idea. Poole said the commission will discuss the issue soon.

"My position is that privacy has to be protected," she said. "I believe cameras in common areas is not a bad thing. I don't think it's going to catch everything."

Poole said she has placed a hiring freeze on vacancies until she can study the agency's needs. She said members of the executive staff have not received annual evaluations in the past even though some have received raises, something she wants to change.

Shown a chart of how DDSN is currently organized with a myriad of arrows and entities, Poole was asked if she thought that was the best model.

"I don't think anything with that many arrows is a good fit," she said.